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1.
Curr Opin Ophthalmol ; 31(6): 462-468, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009077

RESUMO

PURPOSE OF REVIEW: Neuromyelitis optica spectrum disorder is an autoimmune disease that causes optic neuritis and transverse myelitis. Attacks can cause severe neurological damage leading to blindness and paralysis. Understanding of the immunopathogenesis of this disease has led to major breakthroughs in diagnosis and treatment. In the past 18 months, three successful phase 3 clinical trials have been published using targeted approaches to preventing relapses. RECENT FINDINGS: Updates in epidemiology, imaging, quality of life and treatment for acute relapse and prevention have been published in the past 18 months. Epidemiology studies are distinguishing patients based on their antigen specificity for aquaporin-4 and myelin oligodendrocyte glycoprotein, which are increasingly recognized as separate immunological conditions. Imaging by MRI and optical coherence tomography continue to be developed as tools to distinguish neuromyelitis optica spectrum disorders (NMOSD) from other diseases. This is especially relevant as the recent clinical trials showed differences in response between aquaporin-4 seropositive and seronegative patients. The three drugs that were tested for prevention of NMOSD relapses were eculizumab, inebilizumab, and satralizumab. All of the trials were worldwide, placebo-controlled, double-masked studies that demonstrated a clear benefit with each approach. SUMMARY: Recent research in NMOSD has resulted in improved diagnosis and approved treatments.


Assuntos
Neuromielite Óptica , Animais , Aquaporina 4/imunologia , Humanos , Neuromielite Óptica/diagnóstico , Neuromielite Óptica/imunologia , Neuromielite Óptica/patologia , Neurite Óptica , Qualidade de Vida , Recidiva , Prevenção Secundária
2.
Curr Opin Ophthalmol ; 31(6): 483-488, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009080

RESUMO

PURPOSE OF REVIEW: Eye pain is one of the most common presenting symptoms in ophthalmology. It can range from bothersome to debilitating for patients, and it can be vexing for clinicians, especially in the white and quiet eye. The purpose of this review is to provide updates of recent literature regarding eye pain and to communicate our current understanding regarding the evaluation and management of conditions that cause eye pain with a relatively normal examination. RECENT FINDINGS: This review concerns recent literature regarding eye pain in the white and quiet eye. It is arranged by cause of pain and discusses dry eye syndrome, recurrent corneal erosion, postrefractive surgical pain, eye strain, intermittent angle closure, benign essential blepharospasm, trochleodynia, trochleitis and trochlear headache, and posterior scleritis. SUMMARY: Eye pain in the white and quiet eye remains a difficult-to-navigate topic for practitioners. However, a careful history and focused physical examination can elucidate the diagnosis in many cases. Recent updates to the literature have advanced our knowledge of how to identify and treat the underlying causes of eye pain.


Assuntos
Dor Ocular/etiologia , Doença Crônica , Síndromes do Olho Seco/complicações , Dor Ocular/fisiopatologia , Cefaleia , Humanos , Recidiva
3.
J Hematol Oncol ; 13(1): 131, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008453

RESUMO

SARS-CoV-2 has infected millions of people worldwide, but little is known at this time about second infections or reactivation. Here, we report a case of a 55-year-old female undergoing treatment for CD20+ B cell acute lymphoblastic leukemia who experienced a viral reactivation after receiving rituximab, cytarabine, and dasatinib. She was initially hospitalized with COVID-19 in April and developed a high antibody titer with two negative nasal polymerase chain reaction (PCR) swabs for SARS-CoV-2 on discharge. After recovery, she resumed treatment in June for her leukemia, which included rituximab, cytarabine, and dasatinib. She promptly lost her COVID-19 antibodies, and her nasal PCR turned positive in June. She developed a severe COVID-19 pneumonia with lymphopenia, high inflammatory markers, and characteristic bilateral ground-glass opacities on chest CT, requiring high-flow nasal cannula and transfer to the intensive care unit. She received steroids, anticoagulation, and convalescent plasma, and within 48 h she was off oxygen. She was discharged home in stable condition several days later. Given the short time frame from leukemia treatment to PCR positivity and the low case rate in mid-June in New York City, reinfection appears to have been unlikely and SARS-CoV-2 reactivation is a possible explanation. This case illustrates the risks of treating recently recovered COVID-19 patients with immunosuppressive therapy, particularly lymphocyte- and antibody-depleting therapy, and raises new questions about the potential of SARS-CoV-2 reactivation.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/imunologia , Citarabina/uso terapêutico , Imunossupressores/uso terapêutico , Pneumonia Viral/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Rituximab/uso terapêutico , Doença Aguda , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Anticoagulantes/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Citarabina/efeitos adversos , Feminino , Humanos , Imunização Passiva , Imunossupressores/efeitos adversos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , Recidiva , Rituximab/efeitos adversos , Esteroides/uso terapêutico , Resultado do Tratamento
4.
Artigo em Chinês | MEDLINE | ID: mdl-33040500

RESUMO

Objective:To report the nonsurgical correction of congenital auricular deformities in children older than 3 months, analysis the effect and the recurrence and the influencing factors. Method:Patients with auricular deformities who came to our department from July 2017 to August 2019 were collected. EarWell correction was performed for non-invasive correction. Follow-up was performed for at least 3 months after treatment. Data was collected to analysis the effect and the recurrence and the influencing factors. Result:At the end of follow-up, 76 cases of 88 ears were collected, at the end of treatment in this group, the efficiency was 87.5%, and the recurrence rate was 19.48%, 3 months after the end of treatment. There was a statistically significant difference in the distribution of auricle deformities(P=0.018) and the age of first treatment(P=0.028) between children in the effective group and those in the ineffective group. Of all the auricle deformities, the treatment of cryptotia was the most effective, and the effectiveness of prominent ears was the lowest. The family history(P=0.314), gender(P=0.421), and feeding method(P=0.557) of the effective and ineffective groups. There was no significant difference in the gestational weeks at birth(P=0.641), the mode of production(P=0.849), and birth weight(P=0.08). There was no significant difference in age between the relapsed group and the non-relapsed group at the age of first treatment(P=0.833).There was significant difference in the distribution of auricle deformities between the relapsed group and the non-relapsed group(P=0.013). There was no statistically significant difference between the effective group and the ineffective group at the age of first diagnosis and treatment time if we exclude cryptotia. Conclusion:For children who are treated beyond the treatment time window, the main factor affecting the treatment effect is the type of deformity. Nonsurgical correction can still be tried for older than 3 months with auricular deformities, especially for cryptotia, ear wheel deformities, and auricular cavity deformities. We do not recommend to try nonsurgical correction for children older than 3 months with prominent ears and cup ears.


Assuntos
Anormalidades Congênitas , Pavilhão Auricular , Orelha Externa , Criança , Anormalidades Congênitas/terapia , Pavilhão Auricular/anormalidades , Orelha Externa/anormalidades , Humanos , Lactente , Recém-Nascido , Anamnese , Recidiva
5.
Medicine (Baltimore) ; 99(35): e22064, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871966

RESUMO

RATIONALE: Patients with relapsed acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) have poor prognosis. Many patients are not eligible for 2nd HSCT due to organ dysfunction or other complications that prevent them from tolerating conditioning chemotherapy. In those ineligible patients for 2nd HSCT with myeloablative conditioning regimen, reduced intensity conditioning (RIC) are often used. RIC regimens are less toxic but has a less direct anti-tumor efficacy so that RIC regimens are not suitable for the patients with high tumor burden. To overcome this dilemma, Gemtuzumab Ozogamicin (GO) has been used as a part of RIC regimens to add anti-tumor efficacy. We report here a relapsed AML patient who was treated with GO monotherapy followed by stem cell infusion. PATIENT CONCERNS: A 25-year-old male with AML experienced relapse 9 months after allo-HSCT. DIAGNOSIS: Since he had mild renal and cardiac dysfunction and his AML did not progress rapidly, we decided not to give him an intensive chemotherapy. However, after azacitidine (AZA) and donor lymphocyte infusion therapy, his leukemic blasts did not decrease. INTERVENTIONS: Originally, we had planned to proceed with a 2nd allo-HSCT with RIC regimen that consisted of fludarabine, melphalan and fractionated GO (3 mg/m/dose) on day -21, -18, and -15. However, the patient developed appendicitis after the last dose of GO when his neutrophil was 0 cells/µl. Based on his medical acuity, we terminated the rest of the patients conditioning regimen and the patient did not receive any further chemotherapeutics. The patient was still infused with peripheral blood stem cells from the donor on day 0. OUTCOMES: His appendicitis was resolved by antibiotics without surgery. His AML has been in CR more than 18 months under AZA maintenance therapy. LESSONS: GO monotherapy could be a conditioning regimen of 2nd allo HSCT from the same donor as the first HSCT for relapsed AML patients.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Gemtuzumab/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda/terapia , Adulto , Humanos , Masculino , Recidiva , Transplante Homólogo
6.
Arthroscopy ; 36(9): 2377-2379, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891240

RESUMO

The classic and congruent-arc Latarjet techniques are equally safe and effective in restoring glenohumeral stability, even when performed as a revision of a failed stabilization. The classic technique provides a broader contact area for healing and facilitates and improves screw fixation. The congruent-arc technique theoretically optimizes glenohumeral contact forces because of the matched radius of curvature, provides better restoration of glenoid depth, and restores larger glenoid defects. However, rotating the coracoid graft for the congruent-arc technique eliminates the possibility of imbricating the coracoacromial ligament stump to the capsule. Surgeons have little reason to change from one technique to the other; both techniques result in successful outcomes.


Assuntos
Instabilidade Articular , Articulação do Ombro , Atletas , Humanos , Recidiva , Volta ao Esporte
7.
Arthroscopy ; 36(9): 2533-2536, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891253

RESUMO

Historically, a primary anterior instability event has been treated nonoperatively. In the literature, a multitude of outcome scores and definitions for recurrence of instability complicates the interpretation and synthesis of evidence-based recommendations. However, there is an emerging body of high-quality evidence that early surgical stabilization yields better overall outcomes. A wait-and-see approach would be acceptable if it was without detrimental effects, but there is a cost to recurrence of instability events, such as more extensive soft-tissue, cartilage, and bony lesions. Young age, male sex, and contact sport participation have been identified as risk factors for recurrence of anterior shoulder instability, and today, these patients are routinely recommended surgical treatment. It is also paramount to identify concomitant injury following the primary anterior instability event. The sensitivity, specificity, and reliability of radiographs is suboptimal, and the threshold to obtain advanced imaging such as computed tomography or magnetic resonance imaging with 3-dimensional reconstructions should be low. Taking into account the low non-recurrence complication rate following arthroscopic stabilization, early surgical intervention should be considered following the first instability event.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia , Tratamento Conservador , Humanos , Masculino , Recidiva , Reprodutibilidade dos Testes , Ombro
8.
Khirurgiia (Mosk) ; (8): 61-68, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869617

RESUMO

OBJECTIVE: To analyze an opinion of surgeons on advisability, efficacy and choice of topical hemostatic agents. MATERIAL AND METHODS: The research was based on anonymous questioning of surgeons. The questionnaires were developed by using of interactive Google Forms tool (https://www.google.ru/forms). Distribution of questionnaires and invitation of respondents to participation in research were carried out through the Internet. RESULTS: The study enrolled 135 surgeons. Colleagues with considerable experience and length of surgical practice prevailed: 10-15 years - 16 people; 15-20 years - 22 people; over 20 years - 38 people. Opinion of less experienced surgeons was also considered: less than 5 years - 40 people; 5-10 years - 19 people. General surgeons prevailed (49%). Hemostatic sutures (30%) and application of topical hemostatic agents (27%) were the most common methods to stop parenchymal bleeding. Efficacy of local hemostatics is confirmed by small number of cases of recurrent intraoperative bleeding (n=24). Thirty-four respondents reported recurrent bleeding after hemostasis by conventional methods. Postoperative suppuration of hemostatic implant was noted by 9.5% of respondents. Most respondents (77%) prefer combination of hemostatic implants and other traditional methods of hemostasis. CONCLUSION: According to surgeons' opinion, local hemostatic agents are effective for parenchymal bleeding. This method may be used as basic (injury grade I by E. Moore classification) or additional method of hemostasis (grade I-III). Many respondents consider that application of topical hemostatic agent after imposing hemostatic sutures ensures the greatest efficiency of hemostasis. Moreover, placement of the agent over or under sutures seems to be the most advisable.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Hemostáticos/administração & dosagem , Técnicas de Sutura , Administração Tópica , Pesquisas sobre Serviços de Saúde , Humanos , Internet , Recidiva
9.
Middle East Afr J Ophthalmol ; 27(2): 110-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874044

RESUMO

PURPOSE: The purpose is to compare the clinical results of using silk versus nylon sutures for conjunctival autograft suturing in pterygium surgery. METHODS: In this prospective, randomized, controlled, clinical trial 50 eyes from 50 patients with primary nasal pterygium were randomized to undergo pterygium surgery with the use of either nylon sutures or silk sutures for conjunctival autograft suturing. Patients were followed up for 6 months. Main outcome measures included recurrence, postoperative discomfort according to a visual analog scale (VAS), graft hyperemia, and graft edema. RESULTS: According to the results, there was no significant difference between groups regarding recurrence rate of pterygium (P = 0.72). A significant decrease in the mean VAS discomfort score from day 1 to day 14 was observed in both groups (P = 0.001); postoperative discomfort during the first 2 weeks, was not significantly different between the two groups. At 2 weeks' postoperatively, significantly greater number of nylon sutures remained on the autograft (P = 0.021), some of which were buried and could not be removed. CONCLUSION: Both silk and nylon are effective suture materials for autograft suturing in pterygium surgery with similar postoperative discomfort and recurrence rate. Significantly greater number of nylon sutures remains buried on the autograft and could not be removed easily.


Assuntos
Túnica Conjuntiva/transplante , Nylons , Pterígio/cirurgia , Seda , Técnicas de Sutura , Suturas , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/métodos , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Transplante Autólogo , Resultado do Tratamento
10.
Middle East Afr J Ophthalmol ; 27(2): 123-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874046

RESUMO

PURPOSE: The purpose of this study was to evaluate predictive factors for intermittent exotropia (XT) recurrence after bilateral lateral rectus (BLR) recession. METHODS: This is a retrospective chart review of patients with XT who underwent BLR recession surgery between January 2007 and March 2017 with at least one postsurgical follow-up. Forty-one medical records were reviewed. Information collected included age, gender, systemic diseases, history of prematurity, family history of eye diseases, visual acuity, refraction, ocular alignment and control, stereoacuity, slit-lamp examination, fundoscopy, and amount of BLR recession. Successful alignment was defined as ≤8 prism diopters of esotropia or exotropia postoperatively. RESULTS: The mean age of patients at the time of surgery and follow-up time was 9.2 ± 12.3 years (y) and 23.6 ± 36.5 months (m), respectively. The mean amount of BLR recession was 6.5 ± 1.0 mm. Recurrence rate was 43.9% on the last follow-up. Age at surgery and at the time of last follow-up were significantly higher in the recurring group (P = 0.04 and P = 0.05, respectively). Postoperative angle of misalignment during the first 3 months was correlated with exotropia recurrence. No statistical significance was found among the remaining factors studied. CONCLUSIONS: The recurrence rate of XT in our study was 43.9%; it was increased in patients operated at older age and amid those with significant exotropia detected in the early postoperative period (within 3 months of surgery).


Assuntos
Exotropia/diagnóstico , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Adolescente , Criança , Pré-Escolar , Doença Crônica , Exotropia/fisiopatologia , Exotropia/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Oftalmoscopia , Período Pós-Operatório , Recidiva , Refração Ocular , Estudos Retrospectivos , Microscopia com Lâmpada de Fenda , Resultado do Tratamento , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adulto Jovem
11.
Anticancer Res ; 40(9): 5255-5261, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878814

RESUMO

BACKGROUND/AIM: Treatment of recurrent platinum-resistant ovarian cancer remains challenging due to the development of resistance to chemotherapy. Cabazitaxel is a new taxane that has demonstrated beneficial effect in prostate cancer patients resistant to docetaxel. Therefore, it could be anticipated to possibly also have an effect on chemotherapy resistant ovarian cancer. PATIENTS AND METHODS: Twenty-six patients with chemotherapy-resistant epithelial ovarian cancer, fallopian tube or peritoneal cancer were treated with cabazitaxel at a dose of 25 mg/m2 (on day 1 of each 3-week cycle), until progression or inacceptable toxicity, between September 2015 and April 2018. The fraction of patients without progression after three months of treatment was the primary endpoint. Prophylaxis with granulocyte colony-stimulating factor (G-CSF) was prescribed to all patients. RESULTS: The median number of cabazitaxel infusions was 4 (range=1-18). In general, cabazitaxel was well-tolerated. The fraction of patients alive and without progression after 3 months of treatment was 54% (14/26). The response rate was 46% (12/26) according to the Gynecological Cancer Intergroup (GCIG) criteria for CA125. Partial response (PR), evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST), was found in 4/26 patients (15%). By intention-to-treat analysis, the median progression-free survival (PFS) was 3.9 months (95% CI=1.9-4.4) using the combination of CA125 or RECIST (whichever came first), while the median overall survival (OS) was 8.4 months (95% CI=5.1-11.0). CONCLUSION: Cabazitaxel holds promise as a drug in recurrent platinum-resistant ovarian cancer. It demonstrated efficacy and in general, the toxicity was manageable.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Taxoides/uso terapêutico , Adulto , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Esquema de Medicação , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Prognóstico , Qualidade de Vida , Recidiva , Retratamento , Taxoides/administração & dosagem , Taxoides/efeitos adversos , Resultado do Tratamento
12.
Anticancer Res ; 40(9): 5277-5283, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878817

RESUMO

BACKGROUND/AIM: The treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has remained challenging. The effect of salvage chemotherapy (SCT) after nivolumab has been identified recently in other cancer types. The aim of this study was to examine the efficacy of SCT after nivolumab treatment in patients with R/M HNSCC. PATIENTS AND METHODS: A retrospective study was conducted at four institutions in Japan. Fifty-six patients were enrolled in the study. RESULTS: The overall survival (OS) in SCT patients was significantly longer than that in best supportive care (BSC) patients. In the SCT patients, the median OS, median progression-free survival (PFS) and objective response rate (ORR) were 7.3 months, 2.3 months and 36%, respectively. Prognostic factor for OS and ORR was performance score (PS) and previous radiation, respectively. CONCLUSION: SCT after nivolumab is associated with better clinical outcomes in patients with R/M HNSCC compared to those receiving BSC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas de Cabeça e Pescoço/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Nivolumabe/administração & dosagem , Nivolumabe/efeitos adversos , Nivolumabe/uso terapêutico , Recidiva , Retratamento , Terapia de Salvação , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Resultado do Tratamento
13.
Anticancer Res ; 40(9): 5285-5290, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878818

RESUMO

BACKGROUND/AIM: Chemotherapy with additional bevacizumab is the standard treatment for primary and recurrent ovarian cancer. We aimed to investigate the clinical utility and safety of bevacizumab when used in combination with chemotherapy after disease progression. PATIENTS AND METHODS: This retrospective, observational study recruited patients treated for recurrent ovarian cancer from 2014 to 2016. We evaluated the effects of bevacizumab with chemotherapy in patients whose disease had progressed following treatment with bevacizumab. We assessed progression-free survival and adverse events. RESULTS: Thirty-three patients received post-progression treatment with bevacizumab. The median progression-free survival was 8.7 months (95% confidence interval=5.5-11). The progression-free survival was compared pre- and post-progression treatment, and was longer in platinum-resistant than platinum-sensitive cases after treatment (p=0.06). The most common non-hematological toxicity was proteinuria. The incidence of serious adverse events was low. CONCLUSION: Continuous administration of bevacizumab may be beneficial for ovarian cancer patients after disease progression.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Bevacizumab/administração & dosagem , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Prognóstico , Recidiva , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
14.
Anticancer Res ; 40(9): 5295-5299, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878820

RESUMO

BACKGROUND: To assess the prophylactic efficacy of postoperative single intravesical instillation with pirarubicin (THP) and mitomycin C (MMC) for low-risk non-muscle-invasive bladder cancer (NMBC). PATIENTS AND METHODS: A total of 103 clinically low-risk NMBC patients were preoperatively randomized into either THP (n=49) or MMC (n=54) groups. The primary endpoint was recurrence-free survival. RESULTS: The median follow-up periods of the THP and MMC groups were 955 and 1008 days, respectively (p=0.76). Twelve patients (24.5%) in the THP group and 7 (13%) in the MMC group had bladder cancer recurrences. The two-year recurrence-free survival of the THP group and the MMC group was 77.8% and 86.4%, respectively (p=0.20). Neither groups had severe toxicity. CONCLUSION: In low-risk NMBC, the prophylactic effect against postoperative single intravesical instillation with THP was not superior to that with MMC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cuidados Pós-Operatórios , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Terapia Combinada , Cistoscópios , Doxorrubicina/administração & dosagem , Doxorrubicina/análogos & derivados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Gradação de Tumores , Estadiamento de Neoplasias , Recidiva , Resultado do Tratamento , Carga Tumoral , Neoplasias da Bexiga Urinária/diagnóstico
15.
No Shinkei Geka ; 48(9): 827-833, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32938811

RESUMO

We encountered a case of cerebral amyloid angiopathy(CAA)-related cerebral hemorrhage that recurred 20 times within 9 months. The patient was a 68-year-old woman with a history of hypertension, and whose blood pressure was controlled with antihypertensive medicine. She was hospitalized due to cerebral hemorrhage of the right temporal lobe and underwent conservative treatment;however, cerebral hemorrhage of the right frontal lobe recurred on day 60, and 18 cerebral hemorrhages occurred in the following 7 months. Most of the bleeding occurred in the cerebral subcortex, and CAA-related inflammation(CAA-I)had appeared to have developed since subacute progressive cerebral white matter lesions and meningeal contrasting findings were found with MRI. Although cerebral hemorrhage recurrence was not observed for 1 month after steroid pulse therapy, cerebral hemorrhage was subsequently repeated. Thus, in rare cases, CAA-I results in the recurrence of cerebral hemorrhage within a short period of time, and steroids may be effective for preventing this recurrence.


Assuntos
Angiopatia Amiloide Cerebral , Idoso , Hemorragia Cerebral , Feminino , Humanos , Inflamação , Imagem por Ressonância Magnética , Recidiva
16.
N Z Med J ; 133(1520): 73-82, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994595

RESUMO

AIM: Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS: We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS: Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION: In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Mortalidade Hospitalar/tendências , Hospitais Urbanos/estatística & dados numéricos , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Angiografia Coronária/métodos , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Nova Zelândia/etnologia , Alta do Paciente/tendências , Estudos Prospectivos , Recidiva , Estresse Psicológico/epidemiologia , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Centros de Atenção Terciária/estatística & dados numéricos
17.
Epidemiol Infect ; 148: e218, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32951624

RESUMO

'Recurrence' of coronavirus disease 2019 (COVID-19) has triggered numerous discussions of scholars at home and abroad. A total of 44 recurrent cases of COVID-19 and 32 control cases admitted from 11 February to 29 March 2020 to Guanggu Campus of Tongji Hospital affiliated to Tongji Medical College Huazhong University of Science and Technology were enrolled in this study. All the 44 recurrent cases were classified as mild to moderate when the patients were admitted for the second time. The gender and mean age in both cases (recurrent and control) were similar. At least one concomitant disease was observed in 52.27% recurrent cases and 34.38% control cases. The most prevalent comorbidity among them was hypertension. Fever and cough being the most prevalent clinical symptoms in both cases. On comparing both the cases, recurrent cases had markedly elevated concentrations of alanine aminotransferase (ALT) (P = 0.020) and aspartate aminotransferase (AST) (P = 0.007). Moreover, subgroup analysis showed mild to moderate abnormal concentrations of ALT and AST in recurrent cases. The elevated concentrations of ALT and AST may be recognised as predictive markers for the risk of 'recurrence' of COVID-19, which may provide insights into the prevention and control of COVID-19 in the future.


Assuntos
Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Infecções por Coronavirus/enzimologia , Pneumonia Viral/enzimologia , Estudos de Casos e Controles , Tosse , Feminino , Febre , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Recidiva , Estudos Retrospectivos , Fatores de Risco
18.
Vasc Health Risk Manag ; 16: 325-329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982261

RESUMO

Lumivascular optical coherence tomography (OCT) is a novel adjunct in the field of medicine. It offers clear real-time imaging of artery walls before and during endovascular intervention. This study reports our initial experience on the use of lumivascular OCT-guided atherectomy in the management of two patients with recurrent restenosis in their femoropopliteal arteries associated with in-stent restenosis. Endovascular procedures were successful with a Pantheris atherectomy device (Avinger, Redwood City, CA, USA) and drug-eluting balloons. The OCT images clearly distinguished normal anatomy from plaque pathology, were of great advantage in both the accurate diagnosis and treatment of target lesions, and may reduce radiation during the endovascular procedure. However, the price of the device and its need for contrast infusion limit its routine clinical use.


Assuntos
Angioplastia com Balão/instrumentação , Aterectomia , Artéria Femoral/diagnóstico por imagem , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Stents , Tomografia de Coerência Óptica , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Aterectomia/efeitos adversos , Aterectomia/instrumentação , Feminino , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/fisiopatologia , Valor Preditivo dos Testes , Recidiva , Resultado do Tratamento
19.
Mil Med Res ; 7(1): 45, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32962760

RESUMO

BACKGROUND: Gastrointestinal symptoms are not rare among coronavirus disease 2019 (COVID-19) patients, but there have been no reports regarding convalescent plasma therapy for the recovery of gastrointestinal problems in COVID-19 patients. CASE PRESENTATION: We present two cases of patients with COVID-19-associated recurrent diarrhea and positive fecal occult blood who successfully recovered after a one-time convalescent plasma administration. CONCLUSION: When COVID-19 patients develop recurrent or refractory gastrointestinal symptoms and fail to respond to the available treatment, alternative therapy with convalescent plasma administration may be considered.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Diarreia/terapia , Hemorragia Gastrointestinal/terapia , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Idoso , Infecções por Coronavirus/diagnóstico , Diarreia/etiologia , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Imunização Passiva/métodos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Recidiva , Amostragem , Índice de Gravidade de Doença , Taiwan , Resultado do Tratamento
20.
PLoS Negl Trop Dis ; 14(8): e0008648, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32866168

RESUMO

The phenomenon of COVID-19 patients tested positive for SARS-CoV-2 after discharge (redetectable as positive, RP) emerged globally. The data of incidence rate and risk factors for RP event and the clinical features of RP patients may provide recommendations for virus containment and cases management for COVID-19. We prospectively collected and analyzed the epidemiological, clinical and virological data from 285 adult patients with COVID-19 and acquired their definite clinical outcome (getting PCR positive or not during post-discharge surveillance). By March 10, 27 (9.5%) discharged patients had tested positive for SARS-CoV-2 in their nasopharyngeal swab after a median duration of 7·0 days (IQR 5·0-8·0). Compared to first admission, RP patients generally had milder clinical symptoms, lower viral load, shorter length of stay and improved pulmonary conditions at readmission (p<0.05). Elder RP patients (≥ 60 years old) were more likely to be symptomatic compared to younger patients (7/8, 87.5% vs. 3/19, 18.8%, p = 0.001) at readmission. Age, sex, epidemiological history, clinical symptoms and underlying diseases were similar between RP and non-RP patients (p>0.05). A prolonged duration of viral shedding (>10 days) during the first hospitalization [adjusted odds ratio [aOR]: 5.82, 95% confidence interval [CI]: 2.50-13.57 for N gene; aOR: 9.64, 95% CI: 3.91-23.73 for ORF gene] and higher Ct value (ORF) in the third week of the first hospitalization (aOR: 0.69; 95% CI: 0.50-0.95) were associated with RP events. In conclusion, RP events occurred in nearly 10% of COVID-19 patients shortly after the negative tests, were not associated with worsening symptoms and unlikely reflect reinfection. Patients' lack of efficiency in virus clearance was a risk factor for RP result. It is noteworthy that elder RP patients (≥ 60 years old) were more susceptible to clinical symptoms at readmission.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Betacoronavirus/fisiologia , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Alta do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estudos Prospectivos , Recidiva , Fatores de Risco , Eliminação de Partículas Virais , Adulto Jovem
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